Bipolar transurethral enucleation and resection of the prostate versus bipolar resection of the prostate for prostates larger than 60gr: A retrospective study at a single academic tertiary care center

Abstract

Objective:To evaluate the efficacy and safety of bipolar transurethral enucleation and resection of the prostate (B-TUERP) versus bipolar transurethral resection of the prostate (B-TURP) in the treatment of prostates larger than 60g.Material and Methods:Clinical data for 270 BPH patients who underwent B-TUERP and 204 patients who underwent B-TURP for BPH from May 2007 to May 2013 at our center were retrospectively analyzed. Outcome measures included operative time, decreased hemoglobin level, total prostate specific antigen (TPSA), International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), quality of life (QoL) score, post void residual urine volume (RUV), bladder irrigation duration, hospital stay, and the weight of resected prostatic tissue. Other measures included perioperative complications including transurethral resection syndrome (TURS), hyponatremia, blood transfusion, bleeding requiring surgery, postoperative acute urinary retention, urine incontinence and urinary sepsis. Patients in both groups were followed for two years.Results:Compared with the B-TURP group, the B-TUERP group had shorter operative time, postoperative bladder irrigation duration and hospital stay, a greater amount of resected prostatic tissue, less postoperative hemoglobin decrease, better postoperative IPSS and Qmax, as well as lower incidences of hyponatremia, urinary sepsis, blood transfusion requirement, urine incontinence and reoperation (P<0.05 for all).Conclusions:B-TUERP is superior to B-TURP in the management of large volume BPH in terms of efficacy and safety, but this finding needs to be validated in further prospective, randomized, controlled studies.

The Clinical Effect of Bipolar Transurethral Resection in Saline of Benign Prostate Hyperplasia with Long Term Follow-Up

“…Ahmad et al reported that the duration of the resection and operating time was shorter in M-TURP than B-TURP and suggested urologists save time by using M-TURP [7]. Transurethral plasmakinetic enucleation and resection of the prostate (TUERP) is superior to B-TURP in the management of large volume BPH in terms of efficacy and safety, but needs to be validated in further prospective, randomized, controlled studies [18]. A steep operative learning curve may be the main obstacle to the widespread use of TUERP [19].…”

Transurethral Enucleation and Resection of the Prostate: Contemporary Role in the Surgical Treatment of Benign Prostatic Hyperplasia

“…Nevertheless, almost all patients experience gradual improvement over a period of 3-6 months [32,33]. Moreover, looking at the rate of urethral stricture and bladder neck contracture, no difference has been noticed between TUERP and TURP [27].…”

“…Although functional outcomes were comparable, the significant difference in the amount of removed tissue and postoperative PSA and PVR may support a more durable symptom relieve in favor of TUERP. Another retrospective study assessed the outcome of bipolar TUERP versus bipolar TURP for prostates larger than 60 ml [27]. In that study TUERP had a better outcome in terms of operative time, irrigation time and hospital stay.…”

“…This observation could be explained by its shorter operative time, early control of bleeders during enucleation and lower risk of capsular perforation. Furthermore, with the advent of plasma kinetics, the risk of TUR-syndrome with TUERP has further declined to negligible values [27,28,34]. Moreover, blood loss is another frequent complication that has been shown by several studies to be less frequent with TUERP than with TURP or open prostatectomy [28,29,34].…”

“…This can probably explain the reported 3%-15% 5-year reoperation rate after TURP. However, because TUERP provides complete removal of adenoma, its rate of reoperation has been reported to be 0% at 2 years postoperatively [27].…”